2 Hard Deposits and Exploring ObjectivesDescribe calculus and name the various surfaces on which it can form.Describe the similarities and differences between supragingival and subgingival calculus deposits.Name 3 methods for identification of supragingival calculus and 5 methods for identification of subgingival calculus.Describe the process of calculus formation.Compare the hardness of calculus to that of enamel, dentin, cementum, and bone.
3 Hard Deposits and Exploring Objectives Cont. Discuss the relationship between calculus and dental disease.Identify 3 modes for attachment of calculus to a tooth surface.Describe the composition of calculus.Identify 6 uses of a dental explorer.Describe the design and use of the #17, #23, and ODU 11/12 explorers.Demonstrate appropriate use of the #17, #23, and ODU 11/12 explorers on the dentoform.
4 Hard Deposits Calculus Calcified bacterial plaque Hard, tenacious mass forming on teeth (primary or permanent), dentures, & other dental appliances
10 Hard Deposits Calculus formation Pellicle --> (colonization) --> Plaque --> (mineralization) --> CalculusSaliva provides elements for calcification of supragingival depositsGingival sulcus fluid provides elements for mineralization of subgingival depositsAverage time for plaque to mineralize into calculus is 12 days (Range= 10 to 20 days)Mineralization of plaque may begin as soon as 12 to 24 hoursForms in layers parallel with tooth surfaceIncremental lines form between layers of calculus
11 Hard Deposits Hardness of calculus % inorganic substance 96% enamel 65% dentin45-50% cementum/bone**the higher the inorganic %, the greater the degree of calcification
12 Hard Deposits Relationship to disease Calculus is a plaque haven Calculus is the result (NOT the cause) of pocket formationPlaque forming on top of calculus is nearly impossible to remove (rough surface harbors plaque; tears floss)If calculus is removed, the smooth tooth surface makes plaque removal effectiveCalculus holds toxic by-products of plaque in contact with gingival tissues
13 Hard Deposits Modes of attachment Acquired pellicle- easily removed because there is no mechanical interlockMechanical interlock- locked into irregularities (rough cementum, caries, enamel cracks). Difficult to remove and difficult to assess when completeDirect contact between tooth and calculus matrix- difficult to remove
17 Exploring Design Working end Shank flexible, wire-like circular in cross-sectionlast 1-2mm is referred to as the TIPtapers to a sharp POINTsingle-ended or double-ended (paired or dissimilar ends)Shankstraight or curvedvery flexible
19 Exploring #17 Explorer Tip is at a right angle to the shank Used supragingivally and subgingivally but NOT for caries detection in pits and fissuresGood for deep pockets and anterior teeth
20 Exploring #23 Explorer “Shepard’s hook” Used primarily for caries detection (use is now controversial- some evidence that clinician may actually penetrate thin but sound enamel with explorer tip)Does not adapt well subgingivally
21 Exploring ODU 11/12 Double ended with paired working ends Works well in all segments with shallow sulcus depths
22 Exploring Tactile sensitivity Ability to distinguish relative degrees of roughness and smoothnessTakes a lot of time and effort to refine
23 Exploring Technique Light (no blanching), modified pen grasp Intraoral fulcrum on same arch (except maxillary posterior where it may be impossible to fulcrum on same arch)Carefully insert into sulcus at distal line angleSIDE of tip should be against toothBACK will reach junctional epitheliumDo not direct POINT apicallyCritical that explorer reaches the base of the sulcus
25 Exploring Technique (cont.) Adapt so TIP is flush against the tooth (Adaptation= placement of working end against tooth)Use an exploratory stroke (feeling)Pull motion from base of sulcus to marginal gingiva“Bump” over large pieces of calculus; “drag” over smaller pieces; “fall” into large areas of decay; bump over or fall into defective restorative margins; smooth tooth surface
26 Exploring Stroke direction Vertical and oblique strokes should be used. This directs the explorer at a right angle to the deposit.Horizontal strokes should be avoided. They may cause the explorer to run parallel to the deposit so it will not be detected. Point is directed toward JE- very dangerous!Extend strokes at least 1/2 way across the interproximal surfaces.Roll the explorer in your fingers to maintain adaptationUse wrist action, NOT finger action